[Congressional Record (Bound Edition), Volume 148 (2002), Part 1]
[Senate]
[Pages 738-742]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STROKE TREATMENT AND ONGOING PREVENTION ACT OF 2001

  Mr. REID. I ask unanimous consent the Senate proceed to Calendar No. 
222, S. 1274.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (S. 1274) to amend the Public Health Service Act to 
     provide programs for the prevention, treatment, and 
     rehabilitation of stroke.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. REID. Senators Kennedy and Frist have a technical amendment at 
the desk. I ask unanimous consent the amendment be considered and 
agreed to, and the motion to reconsider be laid upon the table; that 
the bill, as amended, be read a third time, passed, the motion to 
reconsider be laid on the table, and any statements relating thereto be 
printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 2824) was agreed to, as follows:

            (Purpose: To make certain technical corrections)

       On page 12, line 24, strike ``paragraph (1)(E)'' and insert 
     ``paragraph (1)(D)''.
       On page 13, line 1, strike ``paragraphs'' and all that 
     follows through ``2823(a)'' on line 2, and insert ``paragraph 
     (2) of section 2823(b)''
       On page 18, line 14, strike ``(b)'' and insert ``(c)''.
       On page 20, line 12, strike ``(c)'' and insert ``(d)''.

  The bill (S. 1274), as amended, was read the third time and passed, 
as follows:

                                S. 1274

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Stroke Treatment and Ongoing 
     Prevention Act of 2002''.

     SEC. 2. FINDINGS AND GOAL.

       (a) Findings.--Congress makes the following findings:
       (1) Stroke is the third leading cause of death in the 
     United States. Each year over 750,000 Americans suffer a new 
     or recurrent stroke and 160,000 Americans die from stroke.
       (2) Stroke costs the United States $28,000,000,000 in 
     direct costs and $17,400,000,000 in indirect costs, each 
     year.
       (3) Stroke is one of the leading causes of adult disability 
     in the United States. Between 15 percent and 30 percent of 
     stroke survivors are permanently disabled. Presently, there 
     are 4,400,000 stroke survivors living in the United States.
       (4) Members of the general public have difficulty 
     recognizing the symptoms of stroke and are unaware that 
     stroke is a medical emergency. Fifty-eight percent of all 
     stroke patients wait 24 hours or more before presenting at 
     the emergency room. Forty-two percent of individuals over the 
     age of 50 do not recognize numbness or paralysis in the face, 
     arm, or leg as a sign of stroke and 17 percent of them cannot 
     name a single stroke symptom.
       (5) Recent advances in stroke treatment can significantly 
     improve the outcome for stroke patients, but these therapies 
     must be administered properly and promptly. Only 3 percent of 
     stroke patients who are candidates for acute stroke 
     intravenous thrombolytic drug therapy receive the appropriate 
     medication.
       (6) New technologies, therapies, and diagnostic approaches 
     are currently being developed that will extend the 
     therapeutic timeframe and result in greater treatment 
     efficacy for stroke patients.
       (7) Few States and communities have developed and 
     implemented stroke awareness programs, prevention programs, 
     or comprehensive stroke care systems.
       (8) The degree of disability resulting from stroke can be 
     reduced substantially by educating the general public about 
     stroke and by improving the systems for the provision of 
     stroke care in the United States.
       (b) Goal.--It is the goal of this Act to improve the 
     provision of stroke care in every State and territory and in 
     the District of Columbia, and to increase public awareness 
     about the prevention, detection, and treatment of stroke.

     SEC. 3. SYSTEMS FOR STROKE PREVENTION, TREATMENT, AND 
                   REHABILITATION.

       The Public Health Service Act (42 U.S.C. 201 et seq.) is 
     amended by adding at the end the following:

     ``TITLE XXVIII--SYSTEMS FOR STROKE PREVENTION, TREATMENT, AND 
                             REHABILITATION

           ``Part A--Stroke Prevention and Education Campaign

     ``SEC. 2801. STROKE PREVENTION AND EDUCATION CAMPAIGN.

       ``(a) In General.--The Secretary shall carry out a national 
     education and information campaign to promote stroke 
     prevention and increase the number of stroke patients who 
     seek immediate treatment. In implementing such education and 
     information campaign, the Secretary shall avoid duplicating 
     existing stroke education efforts by other Federal Government 
     agencies and may consult with national and local associations 
     that are dedicated to increasing the public awareness of 
     stroke, consumers of stroke awareness products, and providers 
     of stroke care.
       ``(b) Use of Funds.--The Secretary may use amounts 
     appropriated to carry out the campaign described in 
     subsection (a)--
       ``(1) to make public service announcements about the 
     warning signs of stroke and the importance of treating stroke 
     as a medical emergency;
       ``(2) to provide education regarding ways to prevent stroke 
     and the effectiveness of stroke treatment;
       ``(3) to purchase media time and space;
       ``(4) to pay for out-of-pocket advertising production 
     costs;
       ``(5) to test and evaluate advertising and educational 
     materials for effectiveness, especially among groups at high 
     risk for stroke, including women, older adults, and African-
     Americans;
       ``(6) to develop alternative campaigns that are targeted to 
     unique communities, including rural and urban communities, 
     and communities in the `Stroke Belt';
       ``(7) to measure public awareness prior to the start of the 
     campaign on a national level and in targeted communities to 
     provide baseline data that will be used to evaluate the 
     effectiveness of the public awareness efforts; and
       ``(8) to carry out other activities that the Secretary 
     determines will promote prevention practices among the 
     general public and increase the number of stroke patients who 
     seek immediate care.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out subsection (b), $40,000,000 
     for fiscal year 2002, and such sums as may be necessary 
     for each of fiscal years 2003 through 2006.

       ``Part B--General Authorities and Duties of the Secretary

     ``SEC. 2811. ESTABLISHMENT.

       ``(a) In General.--The Secretary shall, with respect to 
     stroke care--
       ``(1) make available, support, and evaluate a grant program 
     to enable a State to develop statewide stroke care systems;

[[Page 739]]

       ``(2) foster the development of appropriate, modern systems 
     of stroke care through the sharing of information among 
     agencies and individuals involved in the study and provision 
     of such care; and
       ``(3) provide to State and local agencies technical 
     assistance.
       ``(b) Grants, Cooperative Agreements, and Contracts.--The 
     Secretary may make grants, and enter into cooperative 
     agreements and contracts, for the purpose of carrying out 
     subsection (a).

     ``SEC. 2812. PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY 
                   AND CLEARINGHOUSE.

       ``(a) In General.--The Secretary shall maintain the Paul 
     Coverdell National Acute Stroke Registry and Clearinghouse 
     by--
       ``(1) continuing to develop and collect specific data 
     points as well as appropriate benchmarks for analyzing care 
     of acute stroke patients;
       ``(2) continuing to design and pilot test prototypes that 
     will measure the delivery of care to patients with acute 
     stroke in order to provide real-time data and analysis to 
     reduce death and disability from stroke and improve the 
     quality of life for acute stroke survivors;
       ``(3) fostering the development of effective, modern stroke 
     care systems (including the development of policies related 
     to emergency services systems) through the sharing of 
     information among agencies and individuals involved in 
     planning, furnishing, and studying such systems;
       ``(4) collecting, compiling, and disseminating information 
     on the achievements of, and problems experienced by, State 
     and local agencies and private entities in developing and 
     implementing stroke care systems and, in carrying out this 
     paragraph, giving special consideration to the unique needs 
     of rural facilities and those facilities with inadequate 
     resources for providing quality prevention, acute treatment, 
     post-acute treatment, and rehabilitation services for stroke 
     patients;
       ``(5) providing technical assistance relating to stroke 
     care systems to State and local agencies; and
       ``(6) carrying out any other activities the Secretary 
     determines to be useful to fulfill the purposes of the Paul 
     Coverdell National Acute Stroke Registry and Clearinghouse.
       ``(b) Research on Stroke.--The Secretary shall, not earlier 
     than 1 year after the date of enactment of the Stroke 
     Treatment and Ongoing Prevention Act of 2002, ensure the 
     availability of published research on stroke or, where 
     necessary, conduct research concerning--
       ``(1) best practices in the prevention, diagnosis, 
     treatment, and rehabilitation of stroke;
       ``(2) barriers to access to currently approved stroke 
     prevention, treatment, and rehabilitation services;
       ``(3) barriers to access to newly developed diagnostic 
     approaches, technologies, and therapies for stroke patients;
       ``(4) the effectiveness of existing public awareness 
     campaigns regarding stroke; and
       ``(5) disparities in the prevention, diagnosis, treatment, 
     and rehabilitation of stroke among different populations.
       ``(c) Certain Research Activities.--In carrying out the 
     activities described in subsection (b), the Secretary may 
     conduct--
       ``(1) studies with respect to all phases of stroke care, 
     including prehospital, acute, post-acute and rehabilitation 
     care;
       ``(2) studies with respect to patient access to currently 
     approved and newly developed stroke prevention and treatment 
     services, including a review of the effect of coverage, 
     coding, and reimbursement practices on access;
       ``(3) studies with respect to the effect of existing public 
     awareness campaigns on stroke; and
       ``(4) any other studies that the Secretary determines are 
     necessary or useful to conduct a thorough and effective 
     research program regarding stroke.
       ``(d) Mechanisms of Support.--In carrying out the 
     activities described in subsection (b), the Secretary may 
     make grants to public and private non-profit entities.
       ``(e) Coordination of Effort.--The Secretary shall ensure 
     the adequate coordination of the activities carried out under 
     this section.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary for each of 
     fiscal years 2002 through 2006 to carry out this section.

       ``Part C--Grants With Respect to State Stroke Care Systems

     ``SEC. 2821. ESTABLISHMENT OF PROGRAM FOR IMPROVING STROKE 
                   CARE.

       ``(a) Grants.--The Secretary shall award grants to States 
     for the purpose of establishing statewide stroke prevention, 
     treatment, and rehabilitation systems.
       ``(b) Use of Funds.--
       ``(1) In general.--The Secretary shall make available 
     grants under subsection (a) for the development and 
     implementation of statewide stroke care systems that provide 
     stroke prevention services and quality acute, post-acute, and 
     rehabilitation care for stroke patients through the 
     development of sufficient resources and infrastructure, 
     including personnel with appropriate training, acute stroke 
     teams, equipment, and procedures necessary to prevent stroke 
     and to treat and rehabilitate stroke patients. In developing 
     and implementing statewide stroke care systems, each State 
     that is awarded such a grant shall--
       ``(A) oversee the design and implementation of the 
     statewide stroke care system;
       ``(B) enhance, develop, and implement model curricula for 
     training emergency medical services personnel, including 
     dispatchers, first responders, emergency medical technicians, 
     and paramedics in the identification, assessment, 
     stabilization, and prehospital treatment of stroke patients;
       ``(C) ensure that stroke patients in the State have access 
     to quality care that is consistent with the standards 
     established by the Secretary under section 2823(c);
       ``(D) establish a support network to provide assistance to 
     facilities with smaller populations of stroke patients or 
     less advanced on-site stroke treatment resources; and
       ``(E) carry out any other activities that the State-
     designated agency determines are useful or necessary for the 
     implementation of the statewide stroke care system.
       ``(2) Access to care.--A State may meet the requirement of 
     paragraph (1)(C) by--
       ``(A) identifying acute stroke centers with personnel, 
     equipment, and procedures adequate to provide quality 
     treatment to patients in the acute phase of stroke consistent 
     with the standards established by the Secretary under section 
     2823(c);
       ``(B) identifying comprehensive stroke centers with 
     advanced personnel, equipment, and procedures to prevent 
     stroke and to treat stroke patients in the acute and post-
     acute phases of stroke and to provide assistance to area 
     facilities with less advanced stroke treatment resources;
       ``(C) identifying stroke rehabilitation centers with 
     personnel, equipment, and procedures to provide quality 
     rehabilitative care to stroke patients consistent with the 
     standards established by the Secretary under section 2823(c); 
     or
       ``(D) carrying out any other activities that the designated 
     State agency determines are necessary or useful.
       ``(3) Support network.--A facility that provides care to 
     stroke patients and that receives support through a support 
     network established under paragraph (1)(D) shall meet the 
     standards and requirements outlined by the State application 
     under paragraph (2) of section 2823(b). The support network 
     may include--
       ``(A) the use of telehealth technology connecting 
     facilities described in such paragraph to more advanced 
     stroke care facilities;
       ``(B) the provision of neuroimaging, lab, and any other 
     equipment necessary to facilitate the establishment of a 
     telehealth network;
       ``(C) the use of phone consultation, where useful;
       ``(D) the use of referral links when a patient needs more 
     advanced care than is available at the facility providing 
     initial care; and
       ``(E) any other assistance determined appropriate by the 
     State.
       ``(c) Planning Grants.--
       ``(1) In general.--The Secretary may award a grant to a 
     State to assist such State in formulating a plan to develop a 
     statewide stroke care system or in otherwise meeting the 
     conditions described in subsection (b) with respect to a 
     grant under this section.
       ``(2) Submission to secretary.--The governor of a State 
     that receives a grant under paragraph (1) shall submit to the 
     Secretary a copy of the plan developed using the amounts 
     provided under such grant. Such plan shall be submitted to 
     the Secretary as soon as practicable after the plan has been 
     developed.
       ``(3) Single grant limitation.--To be eligible to receive a 
     grant under paragraph (1), a State shall not have previously 
     received a grant under such paragraph.
       ``(d) Model Curriculum.--
       ``(1) Development.--The Secretary shall develop a model 
     curriculum for training emergency medical services personnel, 
     including dispatchers, first responders, emergency medical 
     technicians, and paramedics in the identification, 
     assessment, stabilization, and prehospital treatment of 
     stroke patients.
       ``(2) Implementation.--The model curriculum developed under 
     paragraph (1) may be implemented by a State to fulfill the 
     requirements of subsection (b)(1)(B).

     ``SEC. 2822. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS 
                   SUBSEQUENT TO FIRST FISCAL YEAR OF PAYMENTS.

       ``(a) Non-Federal Contributions.--
       ``(1) In general.--The Secretary may not award grants under 
     section 2821(a) unless the State involved agrees, with 
     respect to the costs described in paragraph (2), to make 
     available for each year during which the State receives 
     funding under such section, non-Federal contributions (in 
     cash or in kind under subsection (b)(1)) toward such costs in 
     an amount equal to--
       ``(A) for the second and third fiscal years of such 
     payments to the State, not less than $1 for each $3 of 
     Federal funds provided in such payments for each such fiscal 
     year;
       ``(B) for the fourth fiscal year of such payments to the 
     State, not less than $1 for each

[[Page 740]]

     $2 of Federal funds provided in such payments for such fiscal 
     year; and
       ``(C) for any subsequent fiscal year of such payments to 
     the State, not less than $1 for each $1 of Federal funds 
     provided in such payments for such fiscal year.
       ``(2) Program costs.--The costs referred to in paragraph 
     (1) are the costs to be incurred by the State in carrying out 
     the purpose described in section 2821(b).
       ``(3) Initial year of payments.--The Secretary may not 
     require a State to make non-Federal contributions as a 
     condition of receiving payments under section 2821(a) for the 
     first fiscal year of such payments to the State.
       ``(b) Determination of Amount of Non-Federal 
     Contributions.--With respect to compliance under subsection 
     (a) as a condition of receiving payments under section 
     2811(a)--
       ``(1) a State may make the non-Federal contributions 
     required in such subsection in cash or in kind, fairly 
     evaluated, including plant, equipment, or services; and
       ``(2) the Secretary may not, in making a determination of 
     the amount of non-Federal contributions, include amounts 
     provided by the Federal Government or services assisted or 
     subsidized by a significant extent by the Federal Government.

     ``SEC. 2823. APPLICATION REQUIREMENTS.

       ``(a) Requirement of Application.--The Secretary may not 
     award a grant to a State under section 2821(b) unless an 
     application for the grant is submitted by the State to the 
     Secretary.
       ``(b) Application Process and Guidelines.--The Secretary 
     shall provide for an application process and develop 
     guidelines to assist States in submitting an application 
     under this section that--
       ``(1) outlines the stroke care system and explains how such 
     system will ensure that stroke patients throughout the State 
     have access to quality care in all phases of stroke, 
     consistent with the standards established by the Secretary 
     under subsection (c);
       ``(2) contains standards and requirements for facilities in 
     the State that provide basic preventive services, advanced 
     preventive services, acute stroke care, post-acute stroke 
     care, and rehabilitation services to stroke patients; and
       ``(3) provides for the establishment of a central data 
     reporting and analysis system and for the collection of data 
     from each facility that will provide direct care to stroke 
     patients in the State--
       ``(A) to identify the number of stroke patients treated in 
     the State;
       ``(B) to monitor patient care in the State for stroke 
     patients at all phases of stroke for the purpose of 
     evaluating the diagnosis, treatment, and treatment outcome of 
     such stroke patients;
       ``(C) to identify the total amount of uncompensated and 
     under-compensated stroke care expenditures for each fiscal 
     year by each stroke care facility in the State;
       ``(D) to identify the number of acute stroke patients who 
     receive advanced drug therapy;
       ``(E) to identify patients transferred within the statewide 
     stroke care system, including reasons for such transfer; and
       ``(F) to communicate to the greatest extent practicable 
     with the Paul Coverdell National Acute Stroke Registry and 
     Clearinghouse.
       ``(c) Certain Standards With Respect to Statewide Stroke 
     Care System.--
       ``(1) In general.--The Secretary may not award a grant to a 
     State under section 2821(a) for a fiscal year unless the 
     State agrees that, in carrying out paragraphs (2) and (3), 
     the State will--
       ``(A) adopt standards of care for stroke patients in the 
     acute, post-acute, and rehabilitation phases of stroke; and
       ``(B) in adopting the standards described in subparagraph 
     (A)--
       ``(i) consult with medical, surgical, and nursing specialty 
     groups, hospital associations, voluntary health 
     organizations, State offices of rural health, emergency 
     medical services State and local directors, experts in the 
     use of telecommunications technology to provide stroke care, 
     concerned advocates, and other interested parties;
       ``(ii) conduct hearings on the proposed standards providing 
     adequate notice to the public concerning such hearing; and
       ``(iii) beginning in fiscal year 2004, take into account 
     the national standards of care.
       ``(2) Quality of stroke care.--The highest quality of 
     stroke care shall be the primary goal of the State standards 
     adopted under this subsection.
       ``(3) Approval by secretary.--The Secretary may not make 
     payments to a State under section 2821(a) if the Secretary 
     determines that--
       ``(A) the State has not taken into account national 
     standards in adopting standards under this subsection;
       ``(B) in the case of payments for fiscal year 2004 and 
     subsequent fiscal years, the State has not, in adopting such 
     standards, taken into account the national standards of care 
     and the model system plan developed under subsection (c); or
       ``(C) in the case of payments for fiscal year 2004 and 
     subsequent fiscal years, the State has not provided to the 
     Secretary the information received by the State pursuant to 
     paragraphs (9) and (10) of subsection (a).
       ``(d) Model Stroke Care System Plan.--Not later than 1 year 
     after the date of enactment of the Stroke Treatment and 
     Ongoing Prevention Act of 2002, the Secretary shall develop 
     standards of care for stroke patients in all phases of stroke 
     that may be adopted for guidance by the State and a model 
     plan for the establishment of statewide stroke care systems. 
     Such plan shall--
       ``(1) take into account national standards;
       ``(2) take into account existing State systems and plans; 
     and
       ``(3) take into account the unique needs of urban and rural 
     communities, different regions of the Nation, and States with 
     varying degrees of established stroke care infrastructures;

     ``SEC. 2824. REQUIREMENT OF SUBMISSION OF APPLICATION 
                   CONTAINING CERTAIN AGREEMENTS AND ASSURANCES.

       ``The Secretary may not award grants under section 2821(a) 
     to a State for a fiscal year unless--
       ``(1) the State submits an application for the payments 
     containing agreements in accordance with this part;
       ``(2) the agreements are made through certification from 
     the chief executive officer of the State;
       ``(3) with respect to such agreements, the application 
     provides assurances of compliance satisfactory to the 
     Secretary;
       ``(4) the application contains the plan provisions and the 
     information required to be submitted to the Secretary 
     pursuant to section 2823; and
       ``(5) the application otherwise is in such form, is made in 
     such manner, and contains such agreements, assurances, and 
     information as the Secretary determines to be necessary to 
     carry out this part.

     ``SEC. 2825. RESTRICTIONS ON USE OF PAYMENTS.

       ``(a) In General.--The Secretary may not, except as 
     provided in subsection (b), make payments to a State under 
     section 2821(a) for a fiscal year unless the State involved 
     agrees that the payments will not be expended--
       ``(1) to make cash payments to intended recipients of 
     services provided pursuant to such section;
       ``(2) to satisfy any requirement for the expenditure of 
     non-Federal funds as a condition for the receipt of Federal 
     funds; or
       ``(3) to provide financial assistance to any entity other 
     than a public or nonprofit private entity.
       ``(b) Exception.--If the Secretary finds that the purpose 
     described in section 2821(b) cannot otherwise be carried out, 
     the Secretary may, with respect to an otherwise qualified 
     State, waive the restriction established in subsection 
     (a)(3).

     ``SEC. 2826. FAILURE TO COMPLY WITH AGREEMENTS.

       ``(a) Repayment of Payments.--
       ``(1) Requirement.--The Secretary may, in accordance with 
     subsection (b), require a State to repay any payments 
     received by the State pursuant to section 2821(a) that the 
     Secretary determines were not expended by the State in 
     accordance with the agreements required to be made by the 
     State as a condition of the receipt of payments under such 
     section.
       ``(2) Offset of amounts.--If a State fails to make a 
     repayment required in paragraph (1), the Secretary may offset 
     the amount of the repayment against any amount due to be paid 
     to the State under section 2821(a).
       ``(b) Opportunity for a Hearing.--Before requiring 
     repayment of payments under subsection (a)(1), the Secretary 
     shall provide to the State an opportunity for a hearing.

     ``SEC. 2827. SPECIAL CONSIDERATION.

       ``In awarding grants under this part, the Secretary shall 
     give special consideration to any State that has submitted an 
     application for carrying out programs under such a grant--
       ``(1) in geographic areas in which there is--
       ``(A) a substantial rate of disability resulting from 
     stroke; or
       ``(B) a substantial incidence of stroke; or
       ``(2) that demonstrates a significant need for assistance 
     in establishing a comprehensive stroke care system.

     ``SEC. 2828. TECHNICAL ASSISTANCE AND PROVISION BY SECRETARY 
                   OF SUPPLIES AND SERVICES IN LIEU OF GRANT 
                   FUNDS.

       ``(a) Technical Assistance.--The Secretary shall, without 
     charge to a State receiving payments under section 2821(a), 
     provide to the State (or to any public or nonprofit entity 
     designated by the State) technical assistance with respect to 
     the planning, development, and operation of any program 
     carried out pursuant to section 2821(b). The Secretary may 
     provide such technical assistance directly, through contract, 
     or through grants.
       ``(b) Provision by Secretary of Supplies and Services in 
     Lieu of Grant Funds.--
       ``(1) In general.--Upon the request of a State receiving 
     payments under section 2821(a), the Secretary may, subject to 
     paragraph (2), provide supplies, equipment, and services for 
     the purpose of aiding the State in carrying out section 
     2821(b) and, for such purpose, may detail to the State any 
     officer or employee of the Department of Health and Human 
     Services.
       ``(2) Reduction in payments.--With respect to a request 
     described in paragraph (1), the Secretary shall reduce the 
     amount of payments to the State under section 2821(a) by

[[Page 741]]

     an amount equal to the costs of detailing personnel and the 
     fair market value of any supplies, equipment, or services 
     provided by the Secretary. The Secretary shall, for the 
     payment of expenses incurred in complying with such request, 
     expend the amounts withheld.

     ``SEC. 2829. REPORT BY SECRETARY.

       ``Not later than 3 years after the date of enactment of the 
     Stroke Treatment and Ongoing Prevention Act of 2002, the 
     Secretary shall report to the appropriate committees of 
     Congress on the activities of the States carried out pursuant 
     to section 2821. Such report shall include an assessment of 
     the extent to which Federal and State efforts to develop 
     stroke care systems, including the establishment of support 
     networks and the identification of acute, comprehensive, and 
     rehabilitation stroke centers, where applicable, have 
     increased the number of stroke patients who have received 
     acute stroke consultation or therapy within the appropriate 
     timeframe and reduced the level of disability due to stroke. 
     Such report may include any recommendations of the Secretary 
     for appropriate administrative and legislative initiatives 
     with respect to stroke care.

     ``SEC. 2830. FUNDING.

       ``(a) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this part, $50,000,000 for 
     fiscal year 2002, $75,000,000 for fiscal year 2003, 
     $75,000,000 for fiscal year 2004, $100,000,000 for fiscal 
     year 2005, and $125,000,000 for fiscal year 2006.
       ``(b) Limitation on Administrative Expenses.--A State may 
     use not to exceed 10 percent of amounts received under a 
     grant awarded under section 2821(a) for administrative 
     expenses.

                    ``Part D--Miscellaneous Programs

     ``SEC. 2831. MEDICAL PROFESSIONAL DEVELOPMENT IN ADVANCED 
                   STROKE TREATMENT AND PREVENTION.

       ``(a) In General.--The Secretary may make grants to public 
     and non-profit private entities for the development and 
     implementation of education programs for appropriate medical 
     personnel including medical students, emergency physicians, 
     primary care providers, neurologists, neurosurgeons, and 
     physical therapists in the use of newly developed diagnostic 
     approaches, technologies, and therapies for the prevention 
     and treatment of stroke.
       ``(b) Distribution of Grants.--In awarding grants under 
     subsection (a), the Secretary shall ensure that such grants 
     are equitably distributed among the geographical regions of 
     the United States and between urban and rural populations.
       ``(c) Application.--A public or non-profit private entity 
     desiring a grant under subsection (a) shall prepare and 
     submit to the Secretary an application at such time, in such 
     manner, and containing such information as the Secretary may 
     require, including a plan for the rigorous evaluation of 
     activities carried out with amounts received under such a 
     grant.
       ``(d) Use of Funds.--A public or non-profit private entity 
     shall use amounts received under a grant under this section 
     for the continuing education of appropriate medical personnel 
     in the use of newly developed diagnostic approaches, 
     technologies, and therapies for the prevention and treatment 
     of stroke.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2002 through 2006.

      ``Part E--General Provisions Regarding Parts A, B, C, and D

     ``SEC. 2841. DEFINITIONS.

       ``In this title:
       ``(1) State.--The term `State' means each of the several 
     States, the District of Columbia, the Commonwealth of Puerto 
     Rico, the Indian tribes, the Virgin Islands, Guam, American 
     Samoa, and the Commonwealth of the Northern Mariana Islands.
       ``(2) Stroke care system.--The term `stroke care system' 
     means a statewide system to provide for the diagnosis, 
     prehospital care, hospital definitive care, and 
     rehabilitation of stroke patients.
       ``(3) Stroke.--The term `stroke' means a `brain attack' in 
     which blood flow to the brain is interrupted or in which a 
     blood vessel or aneurysm in the brain breaks or ruptures.

     ``SEC. 2842. CONSULTATIONS.

       ``In carrying out this title, the Secretary shall consult 
     with medical, surgical, rehabilitation, and nursing specialty 
     groups, hospital associations, voluntary health 
     organizations, emergency medical services, State directors, 
     and associations, experts in the use of telecommunication 
     technology to provide stroke care, national disability and 
     consumer organizations representing individuals with 
     disabilities and chronic illnesses, concerned advocates, and 
     other interested parties.''.

  Mr. KENNEDY. Madam President, the Senate has today approved important 
bipartisan legislation to improve the treatment of two afflictions that 
take the lives and blight the health of millions of Americans. The 
Stroke Treatment and Ongoing Prevention Act establishes important new 
initiatives to improve the quality of stroke care for patients across 
America. The Community Access to Emergency Defibrillation Act will make 
these lifesaving medical devices much more widely available in public 
places throughout the country.
  I commend my colleague, Senator Bill Frist, for joining me in 
sponsoring these two measures. Senator Frist and I have worked closely 
on this legislation to establish new initiatives to reduce the grim 
toll of injury and death taken by stroke and cardiac arrest, and I 
commend him for his leadership. We are also grateful to the many 
colleagues on our committee and throughout the Senate who have worked 
with us so effectively on these two proposals.
  Stroke is a national tragedy that leaves no American community 
unscarred. It is the third leading cause of death in the United States. 
Every minute of every day, somewhere in America, a person suffers a 
stroke. Every three minutes, a person dies from a stroke. Strokes take 
the lives of nearly 160,000 Americans each year. Even for those who 
survive, it can have devastating consequences. Over half of all 
survivors are left with a disability.
  Since few Americans recognize the symptoms of stroke, crucial hours 
are often lost before patients receive medical care. The average time 
between the onset of symptoms and medical treatment is a shocking 13 
hours. Emergency medical technicians are often not taught how to 
recognize and manage the symptoms of stroke. Rapid administration of 
clot-dissolving drugs can dramatically improve the outcome of stroke, 
yet fewer than 3 percent of stroke patients now receive such 
medication. If this lifesaving medication were delivered promptly to 
all stroke patients, as many as 90,000 Americans could be spared the 
disabling consequences of stroke.
  Even in hospitals, stroke patients often do not receive the care that 
could save their lives. Treatment by specially trained health care 
providers increases survival and reduces disability due to stroke, but 
a neurologist is the attending physician for only about one in ten 
stroke patients. To save lives, reduce disability and improve the 
quality of stroke care, the Stroke Treatment and Ongoing Prevention Act 
authorizes needed new public health initiatives to enable patients with 
symptoms of stroke to receive timely and effective care.
  The Act establishes a grant program for States to implement systems 
of stroke care that will give health professionals the equipment and 
training they need to treat this disorder. The initial point of contact 
between a stroke patient and medical care is usually an emergency 
medical technician. Grants under the Act may be used to train these 
personnel to provide more effective care to stroke patients in the 
crucial first few moments after an attack.
  The Act provides new resources for States to improve the standard of 
care for stroke patients in hospitals, and to increase the quality of 
stroke care in rural hospitals through improvements in telemedicine.
  The Act directs the Secretary of Health and Human Services to conduct 
a national media campaign to inform the public about the symptoms of 
stroke, so that patients receive prompt medical care. The bill also 
creates the Paul Coverdell Stroke Registry and Clearinghouse, which 
will collect data about the care of stroke patients and assist in the 
development of more effective treatments.
  The Community Access to Emergency Defibrillation Act will increase 
the availability of lifesaving cardiac defibrillators in communities 
throughout the nation. We could save thousands of lives every year if 
defibrillators were more widely available, yet few communities are able 
to make this technology widely accessible.
  The measure approved by the Senate today will establish new 
initiatives to increase access to defibrillators. It will assist 
communities in placing these lifesaving medical devices in public areas 
like schools, workplaces, community centers, and other locations where

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people gather. It will help communities provide training to use and 
maintain the devices, and to coordinate planning with emergency medical 
personnel. The legislation will also assist in placing defibrillators 
in schools so that cardiac arrest can be effectively treated when it 
strikes the youngest and most vulnerable of our citizens.
  Sudden cardiac arrest is a tragedy for families all across America. 
Communities that have already implemented programs to increase public 
access to defibrillators like the extremely successful ``First 
Responder Defibrillator Program'' in Boston have been able to increase 
survival rates by 50 percent. More than 50,000 lives could be saved 
each year if more communities implemented programs such as Boston's.
  The two measures approved by the Senate today can make a significant 
difference in the lives of the thousands of Americans who suffer a 
stroke or cardiac arrest every year. For such patients, even a few 
minutes' delay in receiving treatment can make the difference between 
healthy survival and disability or death. We need to do all we can to 
see that those precious minutes are not wasted. This legislation is 
important to every community in America. I commend my colleagues for 
having approved these measures, and I urge our colleagues in the House 
of Representatives to act on them promptly.

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